Bone fragment reduction and re-fixation are core parts of trauma surgery. Often bone fragments are manipulated and held in place with simple pushers, e.g., Ball Spike Pusher such as shown in FIG. 1. It is often desired to achieve refixation by inserting a screw into the bone fragment while still applying pressure on the reduction.
The pushers are often combined with so called spiked disks for footplates. FIG. 2 shows such a prior art pusher with a footplate. The footplate is a disk which is pivotably mounted on a part-spherical end of the pusher and includes bone contacting spikes. This allows for a constant interface with the bone while the pusher itself (with the handle) can be pivoted (swiveled) around the connection point to allow the application of force in a range of angles and to accommodate for the direction of the incision.
A typical problem is that the fracture reduction has to be held in place while trying to fix it, for example with a bone screw. The hole for the bone screw is prepared using a drill guide, which also has to be held in place.
Providing devices which holds the fragment and additionally simultaneously fix the fracture with a bone screw can cause several problems:                1) Space: The space in the surgical field and more specifically in the surgical window is very limited. To have one device for holding the fragment and another one for guiding the drill for the screw preparation and insertion next to each other is difficult.        2) Number of hands: If one of the surgeon's hands is required to keep pushing on a fragment and one hand to hold the drill, there is no free hand to use or manipulate a drill guide. An assistant physician needs to help out so the procedure gets more complicated, two people have to coordinate actions which is much more difficult than one physician pursuing a strategy to reduce the fracture.        3) Size of bone fragment: When pushing on a very small fragment, sometime there is not enough fragment-area adjacent the pusher to place a screw.        
Also it should be mentioned that especially in regions with soft bone the screws should be inserted with a washer because otherwise the screw-head can sink into the bone too easily to apply compression to fix the fracture.